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Syphilis - Rapid Plasma Reagin (RPR)

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Syphilis is a highly infectious sexually transmitted disease caused by the bacteria Treponema pallidum. Transmission of syphilis requires direct contact with a syphilis sore typically on the vagina, anus, rectum, lips, or mouth.

Syphilis testing at Health Testing Centers (HTC) is performed through the rapid plasma reagin (RPR) blood test. The RPR test can confirm the presence of Treponema pallidum bacteria before syphilis symptoms appear. The RPR test measures levels of antibodies that the body produces to fight the Treponema pallidum infection. A non-reactive result indicates that you do not have syphilis.

The symptoms of syphilis are numerous and often indistinguishable from those of other diseases. If untreated, syphilis can cause irreversible damage to the brain, heart, eyes, bones, nerves, and other body tissues. In some cases damage from syphilis can be fatal.

What Is Syphilis?

Syphilis is a potentially curable sexually transmitted disease (STD) caused by the spirochaete bacterium Treponema pallidum. Syphilis is passed through vaginal, anal, or oral sex. The organism can also be transmitted from a mother to her unborn child, either in pregnancy or during the birth process.

The disease remains a serious public health issue, particularly among people who engage in risky sexual behaviors. Although syphilis rates in the United States have declined 1.6 percent overall since 2009, this statistic masks the fact that syphilis incidence has increased in certain key demographics and in certain geographical areas, notably urban centers throughout the U.S. and rural areas in the South.

The Four Stages of Syphilis

Signs and symptoms of syphilis vary according to whether the disease is in its primary, secondary, tertiary or latent stage.

Primary syphilis: The distinguishing characteristic of primary syphilis is a hard, painless sore called a chancre. The chancre typically forms at the point of sexual contact within 3 to 90 days after exposure and heals without treatment within three to six weeks. In many instances, lymph nodes proximal to the chancre sore will become inflamed. Since 44 percent of women infected with syphilis develop chancre sores on their cervix, they may not realize they have been infected with the disease.

Secondary syphilis: Six weeks to six months after exposure, individuals infected with syphilis typically develop a skin rash. The rash usually affects the hands and soles of the feet, but can appear anywhere on the body. These lesions contain active Treponema pallidum bacteria, and other people coming into contact with these lesions can be infected with syphilis. The rash associated with secondary syphilis is frequently mistaken for other skin diseases, which makes serologic testing absolutely essential for any sexually active individual who develops dermatological symptoms.

In rare instances, other symptoms are also associated with secondary syphilis including fever, sore throat, weight loss, headaches and general malaise. Untreated, these symptoms generally resolve within three to six weeks after they appear. Approximately 25 percent of all people infected with syphilis report a subsequent appearances of symptoms associated with secondary syphilis, however, at some point during the first few years of the latent stage.

Latent syphilis: Syphilis goes into a period of dormancy for a period of three to 15 years after initial exposure. During this interval, infected individuals will be asymptomatic, but they will test positive for the disease if an RPR blood test or other serologic blood test is done.

Tertiary syphilis: Without treatment, between 15 and 35 percent of all people infected with the disease will go on to develop tertiary syphilis. Tertiary syphilis is associated with involvement of internal organs like the heart, the brain, the spinal cord and the liver. Tertiary syphilis causes symptoms that can be severe, disabling and in some cases, fatal.

Congenital syphilis: Mother infected with syphilis can pass on the disease to their infants during pregnancy or the birth process. In 40 percent of all cases, untreated congenital syphilis results in infant death. The Centers for Disease Control and Prevention (CDC) recommend that syphilis screening tests be administered to every pregnant woman.

The Link between Syphilis and HIV

If you have syphilis, you are two to five times more likely to become infected with the HIV virus. The chancre sores associated with primary syphilis often form on the genitals, anus and mouth where they cannot be seen, and they bleed easily upon contact, making this an easy infection route for HIV during unprotected sex with HIV-positive partners. In some urban areas, the co-infection rate between syphilis and HIV is as high as 70 percent.

Syphilis progresses faster from its primary to tertiary stages in HIV-infected individuals. Tertiary syphilis is also far more likely to be associated with serious complications in HIV-infected individuals than it is in uninfected members of the general population.

Syphilis Treatment

In its primary and secondary stages, syphilis is easily treated. The standard treatment is a single dose of parenteral penicillin, administered either intravenously or as an injection. In the latent stage, syphilis is typically treated with weekly doses of penicillin, administered over an interval of three weeks. An individual is considered to be cured when a serologic blood test no longer shows evidence of Treponema pallidum bacterial infection.

Unfortunately, antibiotic treatment is far less effective for individuals with tertiary syphilis, particularly for those exhibiting nervous system damage. Even in those instances when antibiotic treatment for late stage syphilis does prove effective, it cannot reverse damage that's already been done to internal organs.

Successful syphilis treatment will not prevent an individual from becoming infected with syphilis a subsequent time. The CDC recommends that all individuals who engage in high risk sexual behaviors undergo regular syphilis testing. Since chancre sores often occur in hidden parts of the body like the cervix, the rectum or the mouth, it's not possible to know whether a sex partner has syphilis by sight alone.